Provider Demographics
NPI:1376004390
Name:WALKER-AMADASUN, KATHLEEN W (RN MSN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:W
Last Name:WALKER-AMADASUN
Suffix:
Gender:F
Credentials:RN MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10990 GALEN PL
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1743
Mailing Address - Country:US
Mailing Address - Phone:770-623-3713
Mailing Address - Fax:
Practice Address - Street 1:10990 GALEN PLACE
Practice Address - Street 2:
Practice Address - City:JOHNSCREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-3009
Practice Address - Country:US
Practice Address - Phone:770-637-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-31
Last Update Date:2019-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN131297390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program